Provider Demographics
NPI:1205683034
Name:FARAH, ABDIRAHMAN AHMED
Entity type:Individual
Prefix:
First Name:ABDIRAHMAN
Middle Name:AHMED
Last Name:FARAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 DRISCOLL DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-3041
Mailing Address - Country:US
Mailing Address - Phone:608-772-4480
Mailing Address - Fax:
Practice Address - Street 1:6002 DRISCOLL DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-3041
Practice Address - Country:US
Practice Address - Phone:608-772-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0020019251E00000X
WI0020011251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health